Whiplash- a pain in the neck

Whiplash is a term to describe a sprain/strain injury to the neck caused by a significant jarring to the spine and stretching of the tissues.  This term is commonly used when describing a neck injury in an automobile accident but can also be applied when the neck is injured in sports, a fall, or other trauma. The over-extension and/or  flexion of the neck causes the muscles, ligaments, joint capsules, and tendons to be stretched beyond their normal capabilities and tissue injury occurs. 

Symptoms

Whiplash associated disorders (WAD) have  been categorized  into four categories based on the severity of the signs and symptoms:

1. Grade 0- you do not have any symptoms or physical signs
2. Grade 1- you have pain and discomfort  but no physical signs
3. Grade 2- you have pain and discomfort with physical muscle and joint signs
4. Grade 3- you have physical signs and neurological changes
5. Grade 4- You have neck complaints with fracture or dislocation

Often whiplash symptoms to not appear till the next day or sometimes 2-3 days after the injury. The most common symptom is neck pain and the intensity of symptoms vary widely between patients correlating with the severity of the injury.  

Common symptoms can include:

-neck stiffness
-headaches (common at the base of the skull)
-trouble sleeping
-mid back and low back pain
-change in range of motion of the neck
-muscle fatigue (worsening throughout the day)
​ 
More severe symptoms include:
-dizziness
-blurred vision
-ringing in the ears
-Arm pain or numbness
-depression
​-difficulty with concentration or memory
-difficulty swallowing
It is important to seek medical attention if you suffer from any of these more severe symptoms after your injury. 

Treatment of Whiplash

It is important to seek treatment if you suspect you have suffered a whiplash injury. You must seek medical attention if you have endured a significant trauma to your spine or have sustained a head injury.  A medical doctor will examine you and order imaging, such as x-ray, if they feel it is needed. 
Once any serious problems have been ruled out, a proper assessment of the spine and the surrounding structures will ensure a quicker recovery and help to avoid any long term development of a compensation pattern that can lead to osteoarthritis later on.  In grade 2-4 WAD injuries, there is a risk of causing hyper-mobility of the neck joints due to the fact that the stabilizing tissues (ligaments and muscles) are over stretched.  This can cause the muscles of the neck and mid back to tighten up and be chronically irritated as well as the joints to have too much movement.  Over time these problems can lead to arthritis in the spine. 

Initial treatment of whiplash should include applying ice and using over the counter anti-inflammatory medications to help manage the pain and swelling. This should be done over the first 2 or 3 days. It is important to maintain movement and to keep active.  Research shows that prolonged rest or wearing a neck brace to prevent movement can prolong recovery. 
It is important to start regular treatments to the neck and mid back. Most grade 1 and 2 whiplash injuries will resolve within 4 to 6 weeks.  Grade 3 and 4 whiplash injuries, all though rare, can take much longer depending on the structural damage to your neck.  
Treatment guidelines for neck pain due to whiplash  outline that the best practice is to initially seek regular weekly care over a 6 week trial, involving home exercises and stretches.  Multi-modal care has been proven to be the best.  This involves combining therapies including: deep tissue massage, spinal adjustments, short term use of muscle relaxants, yoga, range of motion exercises and stretches. For more information visit: https://www.ccgi-research.com/guidelines.

Keeping Active

Again, it is important to keep moving and doing your normal activities of daily living.
It is not recommended that you sit around and do nothing.  Being active with minor pain will not cause tissue to be damaged. 

Some tips to help with this are:

-Avoid prolonged sitting postures with anterior head positioning
-Avoid contact sports
-Avoid long rides in a vehicle
-Periodically stretch and move around throughout the day
-Avoid lifting heavy objects, such as groceries 
-Adjust your pillow to maximally support your neck during sleep
-Make sure you focus on your recovery not the whiplash
-Make sure you seek care if you feel your mental health has been affected by the injury
-Choose low impact exercises such as walking, swimming, or biking
​-Shorten exercise routines as muscles will fatigue faster

​Activity Fact: Check out this link to help you work on range of motion and neck strengthening: https://www.ccgi-research.com/copy-of-exercise-np-neck-mobility-2